Improving Success of Free Flap Phalloplasty Using an Anatomically Ideal Pedicle
Philip S. Brazio, MD1, Edward C. Ray, MD2.
1University of Southern California, Los Angeles, CA, USA, 2Cedars-Sinai Medical Center, Los Angeles, CA, USA.
A safe, reliable recipient vascular pedicle is essential to gender-affirming free flap phalloplasty in order to provide minimal morbidity, reliable flap survival, and optimal aesthetic and functional outcomes. Several recipient pedicles have been proposed, with limitations including vessel reach, need for arteriovenous loop creation, and femoral artery blow-out. We have adopted an orientation for the deep inferior epigastric recipient vessels that improves vessel reach and minimizes recipient pedicle issues.
Ten consecutive patients undergoing phalloplasty, phallourethroplasty or urethroplasty with either radial forearm or anterolateral thigh flaps retrospectively studied. All ten vascular anastomoses and nerve coaptations were performed in a similar manner, with the recipient epigastric artery and veins exiting the inguinal canal (Figure 1).
Mean follow-up was 201 days (102-435). All ten flaps survived. There were no microvascular complications or partial flap losses (Table 1). Two flaps had partial suture line dehiscence. These went on to heal normally and there was no tissue loss.
Using the inferior epigastric artery and venae comitantes oriented through the inguinal canal is safe and reliable. This technique has significant advantages over more commonly employed techniques of vascularizing free flaps in gender-affirming free flap phalloplasty.
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